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PRIOR AUTHORIZATION FORM Coverage Criteria Covered for pulmonary arterial hypertension PAH when the patient has been diagnosed with primary pulmonary hypertension OR the patient has been diagnosed with secondary pulmonary hypertension due to scleroderma sclerosis or autoimmune disease AND the patient is WHO functional class II III or IV.

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What is prior authorization form?

A prior authorization form is a document that healthcare providers must fill out and submit to an insurance company before certain medical procedures, medications, or services can be approved and covered by insurance.

Who is required to file prior authorization form?

Healthcare providers, including doctors, hospitals, and pharmacies, are usually required to file a prior authorization form when they want to provide a specific medical procedure, medication, or service that requires prior approval from the insurance company.

How to fill out prior authorization form?

Filling out a prior authorization form usually involves providing detailed information about the patient, the specific medical procedure or service requested, the medical necessity of the procedure or service, and any supporting documentation such as medical records or test results. The form must be completed accurately and submitted to the insurance company following their specified guidelines and procedures.

What is the purpose of prior authorization form?

The purpose of a prior authorization form is to ensure that the requested medical procedure, medication, or service meets the insurance company's criteria for coverage and is medically necessary. It helps in preventing unnecessary or inappropriate healthcare expenses and facilitates efficient utilization of resources.

What information must be reported on prior authorization form?

The specific information required on a prior authorization form may vary depending on the insurance company and the type of medical procedure, medication, or service being requested. However, common information often includes patient demographic information, healthcare provider information, details of the requested procedure or service, diagnosis codes, supporting documentation, and any additional information requested by the insurance company.